Cardiovascular Flashcards
Risk factors of DVT
Immobilization, smoking, meds (i.e. OCP, HRT), pregnancy, recent travel, recent surgery, trauma
Criteria for LVH
The most commonly used are the Sokolov-Lyon criteria (S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm).
S-wave in V3 + R-wave in AVL
> 21 in women
> 28 in men
R-wave in AVL
> 9 in women
> 11 in men
Criteria for RVH
Tall R-waves in V1 or V2. R-wave Deviation
Ways to break A-flutter
Adenosine 6mg
Blow into a syringe
Lift left leg
ST-elevation
ST-elevation should be
>1 for first two columns
>2 or > 1.5 in the third column
> 1 in the last column
3 Self Help Strategies for CHF
- Sodium Restriction to 2300 mg per day
- Weight loss if BMI > 40
- Avoid NSAIDs
Patients with a Hx of Angioedema should avoid which medication
ACE - I
ARBs are OK.
Primary Tx for Hypovolemic Hyponatremia
Increase Salt and Water Intake.
What device is needed for patients w/ CHF and a prolonged QRS? (> 100ms)
Biventricular Pacing
What device is needed for a low EF? < 35%?
Defibrillator
Should patients on optimal medical management with Stage D CHF who have expected survival < 1-2 years receive a defibrillator?
No. It will not affect their mortality.
Heart Failure Stage A - Definition
Pt w/ Hx of HTN, DM, Obesity, Metabolic Syndrome, Atherosclerotic Disease
Heart failure Stage B - Definition
Pt w/ evidence of Structural Heart Disease but asymptomatic. This includes hx of MI, asymptomatic valvular disease, e/o L. Ventricular Remodeling (LVH, Reduced EF)
Heart Failure Stage C - Definition
Pt w/ evidence of structural heart disease and symptoms or hx of symptoms
Heart Failure Stage D - Definition
Pt with refractory heart failure requiring specialized intervention
Is stress testing needed for patients with known L. Ventricular Dysfunction and Angina?
No. Next step would be cath and revascularization.
How to uptitrate BB?
The beta blocker trials (MERIT, CIBIS, COMET) increased the doses every 2 weeks - I would use that interval usually.
I have moved towards titrating by phone recently. If someone is feeling well without symptoms of congestion (no dyspnea and no edema), then I am comfortable increasing the beta blocker without an appointment.
But if LVEF is very low, if hypotensive, or if other concerns then I do book them in follow-up sooner to titrate up in person.
In regards to ACEi/ARB though, those can be increased more quickly just depending on blood pressure. If blood pressure is consistently 150/90 mmHg for example, you could just jump straight to lisinopril 40 mg nightly. With ACEi/ARB there is immediate benefit and no transient reduction in cardiac output, so you can titrate those up more quickly just based on blood pressure.
